Precipitous Labor NCLEX Review Care Plans
Nursing Study Guide for Precipitous Labor
Precipitous labor, also known as rapid labor, happens when the patient is only in labor for a few hours before giving birth. Rapid labor can end 3 to 5 hours after regular uterine contractions start.
Precipitous labor occurs quickly and suddenly. From the beginning, the patient usually experiences quick and strong contractions that are spaced closely together. Furthermore, the mother usually feels that there is a sudden urgency to push, indicating that she is ready to go into labor.
In some instances, the mother is not even aware that she is on labor until she is near the end and is actually ready to give birth. There may be complications for both the mother and infant, such as tearing of the mother’s vagina and infections in the infant. However, most cases are relatively uneventful and do not have long term ill effects for both the mother and child.
Normal Labor versus Precipitous Labor
To learn about precipitous labor, a comparison from normal labor must be determined first.
A. Normal Labor
The process of labor and childbirth is divided into 4 stages, typically lasting on a span of 6 to 18 hours:
- First stage: The dilation of the cervix
This is further divided into:
- Early phase. This is also called the latent phase wherein it can last for 20 hours. Contractions at this stage come every 5 to 20 minutes, with duration of 30-60 seconds each. The cervix may also open by about 3 cm and the rupture of membranes, or “bloody show” occurs, indicating of the further opening of the cervix.
- Active phase. This involves the continuous dilation of the cervix occurs until it reaches 8 cm. This is accompanied by increasing frequency and quality of contractions every 2-3 minutes (usually stronger, painful and faster). During this phase, the baby’s head will also descend farther and farther. The rupture of membranes also happens, if it hasn’t previously.
- Transitional phase. At this phase, the cervix has opened to about 8-10 cm and more intense contractions occurring every 2-3 minutes that lasts for 60 seconds or more. By the end of this phase, the birth canal will have formed, allowing for the birthing process.
2. Second stage: The delivery of the baby
This has the following characteristics:
- There is further dilation of the cervix (10 cm) and may last for 20 minutes to 2 hours
- Strong, regular contractions of every 1-3 minutes, lasting for 45-75 seconds
- each. The urge to bear down and push also becomes apparent.
- Crowning of the baby’s head occurs as delivery progresses. After the fetal head is delivered, the shoulders follow along with the rest of the body.
3. Third stage: Delivery of the placenta
The placenta is pushed out within a few minutes after the baby is born. This typically occurs between 5 to 30 minutes after childbirth. Contractions will begin again, as the body readies to detach the placenta from the uterine wall.
4. Fourth stage: Recovery phase
It begins 2 to 3 hours after delivery. Uterine contractions persist so as to re-establish muscle tone and expel remaining placental tissues in the uterus.
B. Precipitous Labor: Signs and Symptoms
In precipitous labor, the birthing process happens within 3 to 5 hours and has the following characteristics:
- Sudden onset of contractions with closely-spaced intervals
- Intense pain with each contraction
- A long contraction that feels never-ending
- An intense pressure in the pelvis accompanied by the urge to bear down
- Urge to pass stools immediately
Causes and Risk Factors of Precipitous Labor
Causes and risk factors of precipitous labor are the following:
- History of multiple deliveries which have weakened the pelvic muscles
- History of rapid labor
- Uterus that contracts with great strength
- History of giving birth to a low-weight baby
- Use of hormones, prostaglandin during labor induction,
- Baby born through the use of fertility drugs
- History of hypertension and related disorders during pregnancy (such as preeclampsia, placental abruption)
- Young maternal age
Complications of Precipitous Labor
Precipitous labor presents risks for the mother and baby. The associated risks for mothers include:
- Tearing and laceration of the cervix and vagina
- Bleeding from the uterus or vagina (postpartum hemorrhage)
- Uterine atony
- Retained placental tissues in the uterus
- Shock (due to loss of blood from the lacerations and tearing)
- Infections (due to delivery in an unsterilized environment, such as the car or bathroom)
- Psychological symptoms such as post-partum blues, etc.
The associated risks for babies include:
- Neonatal infection
- Aspiration of meconium and amniotic fluid
Coping During Precipitous Labor
Due to the nature of the sudden physical and emotional changes associated with precipitous labor, it can be challenging and daunting for the mother on how to cope during labor. Because of this, certain precautions may be done to limit the harrowing experience for the patient. The following are advised to help her cope:
- Advise to seek immediate medical help once signs and symptoms of precipitous labor occurs.
- If the mother has a history of precipitous delivery, it is advisable to plan for contact persons who will be available on call as the due date nears.
- Advise the mother to prepare a labor pack early, especially when the mother is near her expected date of delivery.
- Assist the mother to lay on her side or back.
- Ensure that someone is always available beside the mother for support.
- Coach the patient of breathing techniques.
Nursing Care Plans for Precipitous Labor
Nursing Care Plan 1
Nursing Diagnosis: Fluid Volume Deficit related to blood volume loss secondary to precipitous labor and postpartum hemorrhage as evidenced by lochia rubia of 500 mL in the first 24 hours post-delivery, decrease in red blood cell count/ hemoglobin/ hematocrit levels, skin pallor, heart rate of 120 bpm, blood pressure level of 85/50, and lightheadedness
Desired Outcome: The patient will have a lochia flow of less than one saturated pad per hour, a hemoglobin (HB) level of over 100, blood pressure and heart rate levels within normal range, full level of consciousness, and normal skin color
|Assess vital signs, particularly blood pressure level.||Hypovolemia may lower blood pressure levels and put the patient at risk for hypotensive episodes that may lead to shock.|
|Administer uterotonic agents and other medications as prescribed.||Uterotonic agents are utilized to prevent postpartum hemorrhage. Oxytocin is the first-line prevention of PPH. It is used to decrease the blood flow through the uterus after the delivery of the baby.|
|Assist the physician in performing the appropriate procedure to prevent PPH after a precipitous labor.||The team may be required to perform one or more of the following: Uterine massageTransfusion of blood and/or blood productsApplication of pressure on labial or perineal lacerationsEpisiotomy Repair Reduction of uterine inversion using the Johnson method Manual removal of retained placental tissuesSurgery such as hysterectomy (removal of the uterus) or laparatomy|
|Insert an indwelling Foley catheter as indicated.||To accurately monitor the patient’s urine output which can clearly reflect renal perfusion.|
|Commence a fluid balance chart, monitoring the input and output of the patient. Output monitoring should include the amount of blood-soaked pads within 24 hours.||To monitor patient’s fluid balance accurately and to check for any excessive bleeding.|
|Start intravenous therapy as prescribed. Electrolytes may need to be replaced intravenously.||To replenish the fluids and electrolytes lost from blood volume loss, and to promote better blood circulation around the body.|
|Educate the patient (or guardian) on how to fill out a fluid balance chart at bedside.||To help the patient or the guardian take ownership of the patient’s care, encouraging them to drink more fluids as needed, or report any changes to the nursing team.|
|Administer blood transfusion as prescribed.||To increase the hemoglobin level and treat anemia and hypovolemia related to PPH after a precipitous labor.|
|After labor, maintain the patient on bed rest with a leg elevation of 20 to 30 degrees.||To promote recovery and reduce fatigue, bed rest is strongly recommended in patients who had a precipitous labor to prevent postpartum hemorrhage. PPH. Leg elevation is important to obtain good venous return for improved blood flow to the brain and other vital organs. This can also help prevent edema.|
Nursing Care Plan 2
Nursing Diagnosis: Anxiety related to situational crisis of precipitous labor as evidenced by increasing tension, decreased attention span, restlessness, shortness of breath, disorganized thought process, and crying
Desired Outcome: The patient will be able to reduce his/her own anxiety level.
|Assess the anxiety level of the patient, anxiety triggers and symptoms by asking open-ended questions.||To establish a baseline observation of the anxiety level of the patient. Open-ended questions can help explore the thoughts and feelings of the patient regarding the situational crisis.|
|Ensure to speak in a calm and non-threatening manner to the patient. Maintain eye contact when communicating with her. Provide a comfortable environment by providing sufficient lighting, good ventilation, and reduced noise levels. Respect the personal space of the client but sit not too far from him/her.||A calm voice and a comfortable environment can help the patient feel secured and comfortable to speak about his/her worries and fears. The client may become more relaxed and open for discussion if she sees the nurse as calm and appears to be in control.|
|Do not leave the patient when the anxiety levels are high. Re-assure that the healthcare team are here to help her.||To ensure the patient’s safety.|
|Provide factual and honest answer to questions regarding fetal status and contraction pattern.||To ensure that clear information gets to the mother and partner. This might help reduce anxiety levels.|
|Monitor the vital signs of the mother and fetus.||To check if the vital signs have stabilized.|
|Provide a supportive approach when the patient has anxiety by giving simple and short directions or information.||The patient has a limited attention span and is irritable or restless during a panic attack, thus simple and short directions are important in helping the patient cope with the situation.|
|Teach the patient to perform relaxation techniques such as deep breathing exercises, guided imagery, meditation, and progressive muscle relaxation.||To promote relaxation and reduce stress levels.|
|Administer “as needed” or PRN sedative medications only when approved by the labor & delivery team.||Mild sedatives may provide tranquilizing and soothing effect to the patient. However, these should be used with extreme caution during labor.|
Other possible nursing diagnoses:
Ackley, B. J., Ladwig, G. B., Makic, M. B., Martinez-Kratz, M. R., & Zanotti, M. (2020). Nursing diagnoses handbook: An evidence-based guide to planning care. St. Louis, MO: Elsevier. Buy on Amazon
Gulanick, M., & Myers, J. L. (2017). Nursing care plans: Diagnoses, interventions, & outcomes. St. Louis, MO: Elsevier. Buy on Amazon
Ignatavicius, D. D., Workman, M. L., Rebar, C. R., & Heimgartner, N. M. (2018). Medical-surgical nursing: Concepts for interprofessional collaborative care. St. Louis, MO: Elsevier. Buy on Amazon
Silvestri, L. A. (2020). Saunders comprehensive review for the NCLEX-RN examination. St. Louis, MO: Elsevier. Buy on Amazon
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